Exposures For Fear Of Heights
Fear of heights is a very common fear, characterized by an avoidance of high places including staircases, tall buildings, and bridges. Exposure is an effective treatment for fear of heights. Clients sometimes find it difficult to develop appropriate exposure tasks or identify manageable ‘steps’ between behavioral experiments. The Exposures For Heights information handout is designed to help clients and therapists identify feared stimuli, develop exposure hierarchies, and plan appropriate exposure exercises and behavioral experiments. It also contains information about safety-seeking behaviors which may need to be addressed during exposure.
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Introduction & Theoretical Background
The fears that people struggle with can be organized according to their focus. Tolin (2012) suggests that the most common sources of fear relate to:
- Specific situations or objects (e.g., fear of dogs, fear of crowded places)
- Bodily sensations (e.g., heart palpitations, dizziness)
- Social and performance situations
- Obsessive fears
- Excessive worries
- Post-traumatic fears (e.g., beliefs that one is still in danger even after the threat has passed, or memories of trauma which are accompanied by high levels of fear)
Exposure is one of the most effective interventions for overcoming fear (Hofmann & Smits, 2008). It involves individuals repeatedly facing their fears to reduce their fearful responses and reverse the patterns of avoidance that perpetuate them (Springer & Tolin, 2020). Exposure is a first-line intervention for some conditions (such as phobias), and is an essential treatment component for many others (such as panic, social anxiety, OCD, and PTSD).
Therapist Guidance
We’ve talked about how exposure can help people overcome fear. I’d like to show you some examples of how other people have used it to address difficulties like yours. We can use these examples to think about which exposure exercises you might find helpful. Can we look at it together?
Useful questions to support this tool include:
- Which items on this list would make you feel afraid or anxious?
- Which items would you usually avoid because of your fear?
- Which items would you endure with distress or discomfort?
- Can you think of any other scenarios that would make you feel afraid?
- Which safety behaviors do you use to cope with your fear?
- Can you think of any other safety behaviors or coping strategies you sometimes use?
- Does the process of facing your fears make sense? How might you start exposure?
- How could you enhance the exposure(s) you are planning
References And Further Reading
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. Basic Books.
Coelho, C. M., Waters, A. M., Hine, T. J., & Wallis, G. (2009). The use of virtual reality in acrophobia research and treatment. Journal of Anxiety Disorders, 23, 563-574. DOI: 10.1016/j.janxdis.2009.01.014.
Craske, M. (2015). Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. Verhaltenstherapie, 25, 134-143. DOI: 10.1159/000381574.
Depla, M. F., Ten Have, M. L., van Balkom, A. J., & de Graaf, R. (2008). Specific fears and phobias in the general population: Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology, 43, 200-208. DOI: 10.1007/s00127-007-0291-z.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35, https://doi.org/10.1037/0033-2909.99.1.20
Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: